本文選題：冠狀動(dòng)脈旁路移植術(shù) + 紅細(xì)胞輸注�。� 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的目前對(duì)圍手術(shù)期輸注紅細(xì)胞是否會(huì)增加患者術(shù)后橋血管再狹窄的風(fēng)險(xiǎn)這一問(wèn)題,學(xué)術(shù)界尚未有系統(tǒng)研究及詳細(xì)論述。本研究通過(guò)對(duì)比兩組術(shù)后患者橋血管通暢率,來(lái)對(duì)不停跳下冠狀動(dòng)脈旁路移植術(shù)(off-pump coronary artery OPCAB)圍術(shù)期輸入紅細(xì)胞對(duì)于術(shù)后近期橋血管通暢率的影響這一問(wèn)題,進(jìn)行初步探討。方法選擇2013年6月至2015年6月在安徽醫(yī)科大學(xué)第一附屬醫(yī)院行OPCAB的127例(共127例,失訪21例,數(shù)據(jù)較完整106例)患者,依據(jù)患者圍術(shù)期紅細(xì)胞的使用與否分為兩組:組Ⅰ(輸注紅細(xì)胞組,71例);組Ⅱ(未輸注紅細(xì)胞組,35例)。所有選入患者,必須有同一手術(shù)者完成手術(shù),并按照一定排除標(biāo)準(zhǔn),排除不符合要求的病例。術(shù)前完善患者的臨床基礎(chǔ)資料,包括:年齡,身高,體重,高血壓,糖尿病,高血脂,吸煙史,家族史,左室射血分?jǐn)?shù)(left ventricular ejection fraction LVEF),是否使用主動(dòng)脈內(nèi)球囊反搏輔助(Intraaortic Balloon Counterppulsation IABP)等資料,通過(guò)統(tǒng)計(jì)學(xué)方法進(jìn)行分析。圍手術(shù)期觀測(cè)臨床資料包括:手術(shù)時(shí)間,術(shù)后停留ICU時(shí)間,呼吸機(jī)輔助呼吸時(shí)間,靜脈使用抗生素時(shí)間,住院天數(shù)及住院總費(fèi)用。術(shù)后常規(guī)復(fù)查心電圖,胸片及心臟彩超等檢查。對(duì)其臨床資料進(jìn)行分析。結(jié)果通過(guò)統(tǒng)計(jì)學(xué)方法進(jìn)行統(tǒng)計(jì)分析,發(fā)現(xiàn)組‖橋血管通暢率高于組Ⅰ(P㩳0.05),并且組‖大隱靜脈(GVS)橋血管通暢率高于組Ⅰ(P㩳0.05),而兩組間左乳內(nèi)動(dòng)脈(LIMA)橋血管通暢率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P㧐0.05)。此外,通過(guò)對(duì)圍手術(shù)期臨床資料的對(duì)比分析,可以發(fā)現(xiàn)組Ⅰ停留監(jiān)護(hù)病房時(shí)間大于組‖(t=4.50,P=0),術(shù)后靜脈使用抗生素天數(shù)組Ⅰ長(zhǎng)于組‖(t=4.21,P=0),住院費(fèi)用(t=4.86)及住院總天數(shù)(t=6.54)組Ⅰ均高于組‖(P=0)。結(jié)論不停跳冠狀動(dòng)脈移植術(shù)圍手術(shù)期輸血會(huì)加大近期大隱靜脈橋血管再狹窄的發(fā)生率,同樣也會(huì)增加術(shù)后近期橋血管再狹窄的風(fēng)險(xiǎn)。
[Abstract]:Objective at present, whether the perioperative transfusion of red blood cells will increase the risk of postoperative graft restenosis in patients has not been systematically studied and discussed in detail in academic circles. In this study, we compared the patency rate of graft vessels between the two groups, and discussed the effect of red blood cell infusion during off-pump coronary artery OPCAB) operation on the patency of graft vessels in the short term after coronary artery bypass grafting (CABG). Methods from June 2013 to June 2015, 127 patients (127 cases) who were treated with OPCAB in the first affiliated Hospital of Anhui Medical University, including 21 cases of missing visit and 106 cases of complete data, were selected. The patients were divided into two groups according to the perioperative use of red blood cells: group 鈪，

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